Academy of Chiropractic
Doctor’s PI Program

Quickie Consult 1076

Infrastructure 234 I

From the Desk of Dr. Mark Studin

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

"Carriers SIU Came to my Office"


Dr. Studin: What's going on now?

Guest Doctor: Not much, everything's good. So, I called because I needed some advice. So, I've been in practice for 20 years and off and on, this goes on, where I will have an inspector from an insurance company come by and want to inspect the premises. And I've always been instructed not to let them in by my attorney and I just asked them for their card and that's it. I escort them out and I have my attorney contact them.

Dr. Studin: Did they call or just show up and Flash a card?

Guest Doctor: They just show up and flash a card. And in the last three weeks, I've had probably three different insurance companies do it. So, they must be making the rounds. I don't know why.

Dr. Studin: I can tell you why but first, let's explain the why then we'll explain the why.

The why is that insurance companies share profiles on everybody. You've been profiled, so you're coming up on the same algorithm with every insurance company and so, and that's what they do and will be one after the next, after the next. Now it could be that you're just a top producer in your area, or you're doing something wrong in a documentation scenario and you’re committing fraud. Now I know you, I know your practice, you're not committing fraud, you're probably not having any documentation issues. But one of the things I would like to do and to be proactive is to look at your documentation only because it'll make me feel better. Okay. And I can't remember the last time I looked at your documentation. It's got to be years, correct?

Guest Doctor: Yeah. At least two or three years.

Dr. Studin: Yeah. So, I want you to put together your last PI. Is a PI or managed care or both?

Guest Doctor: Only PI.

Dr. Studin: I want you to put together a list of your last PI patients. And I want you to send me all of your completed intake forms, your completed 99202, 203, 204, 205 history, physical recommendations, everything, your complete report and send me your first soap note attached to it, the first treatment, Okay?

Guest Doctor: Okay.

Dr. Studin: And you're going to have your staff do that. Like as soon as we hang up, but I want you to look at it before they send it that it's complete. Do not redact the patient's name because I'm a HIPAA covered entity like you are and the coach and doctor, you're going to get a second opinion. So you don’t have to do that. Next. Do you have a HIPPA compliant email?

Guest Doctor: I do.

Dr. Studin: Okay. So do I. So, we're good with that. Okay. And then, um, I'm going to look at it and if there's an issue, I'm going to set you up for a compliance review. Uh, but if it's, if it's nonsense and just, you know, whatever, I'll just call you up and give you the full, you know, the little itty-bitty items that you got to work on. Um, so I'm not overly concerned, you know, that’s just the step because it's going to make me feel better. Now here's the what you need to do. You never ever, ever, ever, ever talked to an SIU person. SIU is a special investigative unit and they don't get paid unless they recover money from you and you never know what you're going to say or your staff is going to say, no one talks to them. No one says anything to them.

You just like you did you escort them out…” here is my lawyer's phone number”. And you have a health care lawyer, correct? Not a corporate lawyer? Yes. Okay. You escort them out, give me a lawyer’s phone number. It's the best money you will ever spend. Never, ever, ever talk to them. I made that mistake and I spoke to them and I didn't do anything wrong. And I'm the healer and I'm the big doctor. Less thing. I know. I mean, four years of legal battles over, you know, my stupidity. We probably would have ended up there anyhow, but it probably could have been mitigated to some degree. Okay?

Guest Doctor: Okay.

Dr. Studin: Clear?

Guest Doctor: Yes.

Dr. Studin: Very good. Send me your documents. I want to look at them later. Alligator

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